It can really be very challenging to properly do … Billing Paravertebral Facet Joint Nerve Destruction or the Radiofrequency Nerve Ablation According to CPT CPT® Changes 2012 explained the reason for the change. “Prior to 2012, the unit of service used to report these procedures was a single nerve at a single vertebral level. However, two nerves innervate each facet joint, and there are two facet joints at each vertebral level. One or two facet joints at the same level potentially could be treated. As such, the vertebral level is of less significance than the number of facet joints treated, so using vertebral level as the unit of service did not adequately reflect the work performed.” Here are your codes when Billing Paravertebral Facet Joint Nerve Destruction 64633 Destruction by neurolytic agent, paravertebral facet joint nerve (s) with imaging guidance (fluoroscopy or CT); cervical or thoracic; single facet joint +64634 cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure) 64635 Destruction by neurolytic agent, paravertebral facet joint nerve (s) with imaging guidance (fluoroscopy or CT); lumbar or sacral; single facet joint +64636 lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure) POINTS: When Billing Paravertebral Facet Joint Nerve Destruction 1. These codes are no longer billable at a service unit(s) on a per single nerve at a single vertebral level; 2. You have to remember that there are 2 spinal nerves that innervates each single facet joint; 3. Anatomically, there are 2 facet joints (left and right) on each vertebral level; 4. These codes are billable per facet joint; which means, if 2 facet joints were treated on the same vertebral level, then you will report the primary code with a modifier -50 to indicate a bilateral procedure; Know your Spinal Nerves and Focus on them when billing paravertebral facet joint nerve destruction. There’s a total of 31 pairs. Cervical (8 pairs) Thoracic (12 pairs) Lumbar (5 pairs) Sacral (5 pairs) Coccyx (1 pair) Also note that imaging guidance is inclusive and that per the CPT guideline, fluoro or CT (imaging guidance) is required for the performance of these procedures. 77003 is inclusive and not billable when billing paravertebral facet joint nerve destruction. Otherwise, we are being further instructed that if imaging guidance (Fluoro or CT) is not used, it is appropriate to use the unlisted procedure code 64499 (Nervous System). Useful References and Policy Guidelines from other Payers Local Coverage Determination LCD for Destruction of First Coast Florida Ucare Policy for Radiofrequency Ablation for Chronic Spinal Pain Facet Joint Denervation Policy Number 141 Blue Cross Blue...

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